Provider Demographics
NPI:1982814661
Name:BRENNAN, SHAWN CARROLL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:CARROLL
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 504
Mailing Address - Street 2:9 SOUTH QUEEN ST.
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-0504
Mailing Address - Country:US
Mailing Address - Phone:410-658-3066
Mailing Address - Fax:410-658-3611
Practice Address - Street 1:9 SOUTH QUEEN STREET
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-0504
Practice Address - Country:US
Practice Address - Phone:410-658-3066
Practice Address - Fax:410-658-3611
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD75311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice